Hepatocellular carcinoma (HCC) is the 5th most common solid cancer world-wide and the 3rd and 6th most frequent cause of cancer death in men and women, respectively. HCC patients have high death rate and high recurrence rate. The ability to determine HCC survival and HCC recurrence earlier is important.
Currently, the most common diagnosis method for HCC is based on measuring the serum alpha-fetoprotein (AFP) levels in conjunction with hepatic ultrasonography. Ultrasonography screening was found to be cost-effective but has only 60% sensitivity and 97% specificity in cirrhotic patients1. Serum AFP is only elevated in 40-60% of HCC patients largely at a very advanced stage or do not produce AFP at all.
Since many HCC cases are expected to be induced by HBV and Hepatitis C virus (HCV), the HBV and HCV in the patient samples may be a good indicator of clinical outcome. For HCV, previous reports showed that the genotype increases the risk of developing HCC2,3. For HBV, some previous reports showed that HBV genotypes are likely to be important in determining the severity and progression of HBV-induced liver disease4. However, no conclusive result is known. It is known that genotype C HBV is associated with a higher risk of HCC than genotype B HBV, which is probably related to a delayed HBeAg seroconversion, more active hepatitis, and a higher prevalence of basal core promoter mutations 5,6,7 The precore (G1896A) and core promoter (A1762T, G1764A) mutations of the HBV gene are known to be associated with changes in immunologic phase or the progression to complicated liver disease in adults. HBV with TCC at nucleotides 1856 to 1858 of the precore region might represent a specific HBV strain associated with more aggressive liver disease than other genotype C HBV strains8. Sung et al. demonstrated that HBV genotype Ce is associated with a higher risk of HCC and cirrhosis when compared to genotypes B and Cs9. However, the result is not statistically significant.
With the development of health awareness in the general public, HCC comes to medical attention at earlier stages where often it is hard to determine the prognosis using classical histopathological measurements such as tumor multinodularity and vascular invasion.
Furthermore, all previous reports only disclose the relationship between genotypes and the risk of HCC and/or cirrhosis. Currently there is no reliable guide on the relationship between HBV genotypes and other clinical parameters like survival and recurrence.